This thesis presents a literature review of the diagnosis and treatment of lumbar spinal stenosis (LSS), including a brief description of the patient history and non-surgical options while focusing mainly on the current array of surgical techniques. LSS is defined as a narrowing of any part of the lumbar spinal canal. This narrowing places excessive pressure on both the spinal cord and peripheral nerves resulting in pain, numbness and weakness in the lower extremities. LSS has a large spectrum of potential treatment options since the disease itself has a wide range of severities. An extensive physical exam, using the appropriate clinical surveys, physical manipulations, and imaging studies, is of paramount importance in the successful diagnosis. Currently, conservative treatment, while an important first step in managing LSS, seems to be limited to a first line of defense, lasting only a short period of time. Physical therapy results appear to be beneficial for only six months to a year, and despite their increased usage in recent years, management through the use of non-steroidal anti-inflammatory drugs, opiates, and corticosteroid injections seem to provide very little benefit. Surgical treatment for LSS ultimately appears to be the most effective method in reducing pain and disability for the patient who fits the clinical and radiological findings indicative of LSS. Although current surgical options available are numerous, including different types of fusion, bone grafts, and innovative joint replacements, the most promising procedures appear to be minimally invasive lumbar disk replacement surgery and dynamic stabilization. These procedures offer the benefits of a minimally invasive surgical approach, while reducing stenosis though hardware that not only reduces pain but also allows patients to maintain spinal flexibility and natural functional motion.

A research report submitted to the Faculty of Medicine, University of the Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of Medicine in the division of General Surgery. Johannesburg 2012 / Oesophageal cancer causes much morbidity and mortality in South Africa. This disease has a 5-year survival of less than 10% despite improvements in therapy. Most patients present with advanced disease and are suitable only for palliative care. Current standard of palliative care for patients with end-stage oesophageal cancer that present with dysphagia include brachytherapy and stenting. Brachytherapy improves survival and has a more stable quality of life in the long term when compared to stenting. Conversely stenting has a more acute relief of dysphagia. In South Africa many patients with malignant dysphagia face socio-economic constraints that cause delays in therapy, especially in patients from rural areas. Many prospective randomized trials of palliative treatment have been done in the developed world, not taking into account socio-economic constraints. We present a study from Tshepong Hospital (Klerksdorp, North West province), a secondary hospital in South Africa.

Acute thrombotic and thromboembolic occlusion of atherosclerotic vessels are events that precipitate most heart attacks and strokes. In arterial stenotic flow, thrombus formation is shear dependent and may or may not lead to complete occlusion of the vessel. Platelets in whole blood adhere to collagen-coated surfaces and as they accumulate the resistance of the stenosis increases because of the decreasing passageway of the occluded stenosis. As a model of blood clotting in stenoses, porcine blood is heparinized and perfused over tubular glass test sections that are coated with collagen type I. Each test section has a preexisting stenosis and its severity varies so that higher percent stenoses produce higher shear rates on the blood. The hypothesis of this thesis is that high shear rates due to stenosis in arteries are a necessary feature for occlusive thrombosis.

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Afhandling--Copenhagen. / Summary in English and Danish. Includes bibliographical references.